It’s A Family Affair

A daughter gets a wake-up call as she helps her mother deal with food and insulin

By Wendy Pollitt
Special to the Star-Bulletin

STORY SUMMARY »

Dealing with a disease like diabetes can be an arduous task.

Checking your blood sugar levels and taking shots of insulin are just part of it.

There also are dietary restrictions. How on Earth can anyone make sense of what you can and cannot eat, and on top of it all, how much can you eat?

Kaneohe writer Wendy Pollitt came up with a clever plan to help her mother. She took a long list of food exchanges, simplified it and created an easy-to-use chart that she stuck to her refrigerator.

Now, when her mother, who is in her 90s, calls with a question, she can see what Mom sees and help confirm -- or not -- what Mom has in mind.

Not only that, she thought that, given her family's history, taking up this fairly easy-to-adapt diet might be a good preventive tool for her, too.

FULL STORY »

"Mother has diabetes," came my sister's voice across a continent and an ocean.

"Well, of course she does." I replied. "We've known that for years."

"Yeah, but this is the next stage. The pill she's been taking isn't enough any more. She's going to have to do the insulin thing."

This was going to be a problem. I just knew it.

My mother, who has buried two husbands, run a multimillion-dollar corporation, undergone surgery on her inner ear, her knee, and her neck, beaten leukemia into remission and lived her whole life with a congenital heart problem, this strong, strong woman lived in dread of having to inject herself. It was not just a phobia about needles but a revulsion of everything the disease entailed. And with good cause. My grandmother wielding her needle and plunging it into her purple-veined thigh every morning was one of the first things Mother described to me after learning that she would have to inject herself.

"I can't do that." For her, this was waking up from a bad dream to find that she was living the nightmare.

For Mother, the first hurdle was accepting the fact that she now had stage two diabetes. But that was nothing compared to the second, injecting herself with insulin every day. Though she understood the seriousness of her condition, getting her to do what was necessary was going to be a problem. Moving ahead meant trying to understand her fear. It wasn't logical or reasonable, but that didn't make it any less real to her.

And what about her diet? My mother is someone who eats when she's hungry and skips meals when she's not. Definitely a no-no for diabetics. Sweets! Especially chocolate. How was she going to give that up?

Strong and intelligent and nobody's fool, sometimes when my mother doesn't want to do something, or accept a truth, or deal with unpleasantness, she will just repeatedly mess up and throw up her hands in helplessness. This was one of those times. At one point, I thought even the nurse who had been sent to teach her how to test her blood sugar, measure the insulin dose and use the needle was considering calling for reinforcements or even throwing in the towel.

Guidelines for Mom

Breakfast

Lunch

Dinner

1 starch (1)

2 starches (1)

2 starches (1)

1 fruit (4)

1 meat (2)

2 meat (2)

1 milk (5)

1 vegetable (3)

2 vegetable (3)

1 fat (6)

1 fat (6)

1 fruit (4)

free food (7)

free food (7)

2 fat (6)

free food (7)

The second number refers to a list of choices on page D2. Three snacks are also part of the plan. One each between breakfast and lunch, lunch and dinner and dinner and bedtime. It is advised that they be a carbohydrate of some kind: fruit, vegetable, peanut butter and crackers, popcorn etc.

Novo Nordisk Pharmaseuticals, Inc.

For me, this was an eye-opening, awkward moment, a glimpse into that future when parent and child change places. I never saw my mother so tentative in her movements, so hesitant, so unsure of herself. No matter how many times the nurse talked her through the process, Mother would invariably do something backward, leave out a step, and end up so thoroughly confused she had me wondering about her mental state.

Once I realized it was just obdurance on her part, and hopeful insistence that if she couldn't do what had to be done she wouldn't have to do it, I challenged her intelligence, and when she believed she had to prove her mental acuity, she accepted the inevitable and allowed her brain to engage and her memory to recall the sequence.

What had been an hour's struggle became a three-minute fait accompli as her fingers nimbly carried out the process.

Stashed among some papers, I found a discarded chart that laid out in numbered columns the seven food groups: starch, meat, vegetable, fruit, milk, fat, and "freebies," and listed portion sizes for each exchange in the group. I taped it on the refrigerator and told her she was going to work from that chart to learn to make a food plan.

She took one look at the wealth of information on the chart and decided it was more than she could take in, so once again she erected a mental wall between her perfectly agile brain and the words on the page.

"The print's too small," she said.

"Put on your glasses," I rejoined.

"For heaven's sake," she said, "This doesn't make sense. Bread and rice I can understand are starches, but beans and yams are listed in Group 1, too, and everyone knows they are vegetables."

I looked. She was right.

"And here," she continued, jabbing with her finger at an offensive column. "Avocados and nuts are listed right along with butter and mayonnaise as fats! Fats?" she demanded on a rising note. "My goodness, everyone knows avocado is a fruit; it grows on a tree, and nuts are ... well, nuts!" The real deal-breaker was the hot dog. Not chicken or turkey, but the beef and/or pork ones. They counted as both a meat and a fat. At the same time!

"Hmmmpf!" She had the last word.

She would never be able to keep it all straight, she insisted; there was just too much there to take in. It was as if she believed that if she just resisted long enough, and strong enough, the need for the regimen would pffft, disappear. Go away.

"Not gonna happen," I confronted her.

But now the task became: How to get this reduced to a process and proportions she could manage?

And then I had one of those AHA! insights. Sitting down with paper and pencil, I created a simple matrix for her :

The timing was easy, I explained. Start out with when you eat breakfast. Then decide what time you plan to dine. Split the difference, and that hour gets assigned to lunch. Halfway between breakfast and lunch comes the midmorning snack; halfway between lunch and dinner is the mid-afternoon snack. And finally, shortly before bedtime, have another snack. She nodded. So far, so good.

Then I lead her to the chart on the refrigerator.

"Just imagine that you're in a Chinese restaurant," I told her.

"This chart is the menu." All she had to do was follow the matrix and make choices from the appropriate columns. For example, cereal (column 1) and milk (5), sprinkled with some chopped walnuts (6), plus orange juice (4), met the breakfast requirements for one starch, one milk, one fat and one fruit. Coffee was a free food (7).

Initially she balked, but soon came around, admitting that this really was doable.

I copied the chart, and now, when she's in doubt about something, she can call me, 6,000 miles away, and I can see what she is looking at to confirm — or not — her thinking.

My mother is invincible. In her 90s now, she drives around town to the hairdresser, her doctors' appointments, and the grocery store.

She's overcome her diabetes dread, and despite her disease(s), is living an active and fulfilling life, playing bridge, attending the theater, doing charitable work, and going cruising.

The silver lining in my mother's problem? As I was helping her adjust to her new diet, I had been getting a heads-up and a head start. If I adopted this diet for my own now — and it really is sensible rather than onerous — I wondered, might it be preventive and stave off the onset of the disease. Worth thinking about, isn't it?

Guide To Smart Eating

Food exchanges for the special diet for diabetics are broken down into seven categoies. Following is a partial list.